Abstract
Herpes simplex virus (HSV) pneumonia caused by aspiration from the oropharyngeal exudates is described. An 89-year-old Japanese male in a poor performance state complained of appetite loss followed by difficulty in swallowing, and bilateral pulmonary infiltrates with interstitial reactions were radiologically pointed out. Antibiotics administration was ineffective, and he died on the 6th day of hospitalization. At autopsy, HSV-induced multiple mucosal erosions were observed on the tongue, pharynx, epiglottis, and trachea. In bilateral lower lobes of the lung, HSV infected bronchiolar and type-II alveolar cells in association with acute interstitial reactions. The infected cells with intranuclear inclusion bodies were immunoreactive with HSV antiserum. HSV-1 infection was confirmed by immunostaining with monospecific monoclonal antibodies and by type-specific real-time polymerase chain reaction. It is very likely that HSV pneumonia was provoked by aspiration of infected exudates from the upper airway (namely, sequential infection from the tongue, epiglottis, and trachea to lung). Oropharyngeal herpes might cause anorexia and difficulty in swallowing, probably accelerating aspiration. The medical staff did not recognize the oropharyngeal lesions of this aged patient. We must realize again the importance of oral care for hospitalized patients to avoid aspiration pneumonia, including herpetic pneumonia.
Highlights
Pneumonia caused by herpes simplex virus (HSV) is seldom seen in immunocompetent patients
HSV pneumonia usually occurs in immunocompromised patients [5, 6] or in patients with preexisting lung disorders [6, 7]
HSV-1 infection was proven in the tongue, pharynx, epiglottis, trachea, and lung
Summary
Pneumonia caused by herpes simplex virus (HSV) is seldom seen in immunocompetent patients. We experienced an autopsy case of HSV-1 pneumonia in an immunocompetent but old-aged patient. 2. Case Presentation e patient was an 89-year-old Japanese male with past history of hypertension, ascending colon adenocarcinoma, superior mesenteric artery dissection, and dementia. Case Presentation e patient was an 89-year-old Japanese male with past history of hypertension, ascending colon adenocarcinoma, superior mesenteric artery dissection, and dementia He underwent ascending colectomy, while arterial dissection was kept conservatively. He lived in nursing facility by using a wheelchair He complained of appetite loss for four months, and for the recent two weeks, he could not swallow, so that an intravenous drip infusion started. Chest X-ray film showed bilateral pulmonary infiltrates, and CT scan
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